Multihospital Systems: Issues and Empirical Findings

Prologue: The rapid growth of the nation's health care enterprise has become an object of envy on Wall Street and a source of con- cern among private and public payers who foot the bill. One large sector of what Arnold S. Relman has characterized as "the medical- industrial complex" is the multihospital systems chat have been evolving in recent years. Surrounding the growth of these organiza- tions are a number of viewpoints that have become conventional wisdom in many health quarters. These viewpoints include the notion that such systems are growing explosively, that they are more efficient and less costly than the average community or teach- ing hospital, and that they may jeopardize the access that poor people have to medical care. Based on a synthesis of empirical studies, economists Dan Ermann and Jon Gabel of the National Center for Health Services Research challenge many of these con- ventional judgments. Their work certainly provides grist for future research that takes a more penetrating look at what the changing configuration of the hospital industry means in terms of access, cost, and efficiency.